0720-0064_ssa_10.27.22

0720-0064_SSA_10.27.22.docx

MHS GENESIS Patient Registration Module & Patient Portal

OMB: 0720-0064

⚠️ Notice: This form may be outdated. More recent filings and information on OMB 0720-0064 can be found here:

2025-11-26 - Revision of a currently approved collection

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